What is the best way to take my pills?
This question is at the root of more confusion than any other question in medicine. The public wonders about which pill is best for a given disease, and we are constantly under the barrage of pharmaceutical advertising, but the fact still remains that most doctor's prescriptions are not filled. And even when the prescriptions are filled, they are rarely taken as directed. Whose fault: we all share equally, doctor, pharmacist and patient. This is not good, since we are all trying to work together.
I saw a cartoon in a magazine once on this subject. The doctor told the patient "take one pill twice a day". The patient looked confused and then asked " Doc, don't I swallow it the first time?"
One of my sons collected labels from the pharmacy and kept them on a prescription bottle. The instructions were actually comical when viewed from the right perspective. "Do not swallow". "For rectal use only." "Use as directed". "To be put in left eye only". "Not for human consumption". The pharmacist puts these labels on the container to try to prevent accidents. Believe it or not, there will always be someone that thinks a suppository is just a big pill to swallow.
Some medicines are best taken after food so that they won't irritate the stomach; the body doesn't absorb others as well if there is food in the stomach. Some last longer in the body; others may remain in the body for days. And it may be different for each member of the family depending upon things such as size and renal function. It is part of the science of medicine that your doctor has had to learn over the years. The doctor will instruct you about how many times per day a pill should be taken. In most cases, the doctor will be able to limit the number of times per day that you have to take your medicine to two or three. I often try to link medicine taking to either brushing the teeth or to meals as we don't often forget either.
Despite our best efforts, sometimes the doctor will think the instructions, reasons for use, and possible side effects to the patient are perfectly clear. The doctor may even give a written sheet. But if the patient has his or her attention elsewhere there is likely to be miscommunication. This can be the doctor's fault (we can't expect anyone to remember all the instructions if they come after we have given the patient awful results) or the patient's. It doesn't matter who is to blame, it is the patient who may suffer needlessly.
One of the rules that I have always tried to live by as a physician is to continually reassure people that there are no stupid questions when it relates to health. Don't be afraid to ask your doctor to be sure that you are taking medicines correctly. This discussion is so important that I give you the following story from a colleague credited with the discovery that a certain class of medications could be taken under the tongue. A patient with angina (cardiac chest pain) was having more than the usual amount of pain. So his doctor gave him a pill called Isordil (isosorbide dinitrate). One month later, the patient returned feeling better almost within minutes after taking each pill. In the course of discussing this with his doctor (who knew that it takes 30 to 45 minutes for the pill to work) he complained about the pill being bitter and tingling under the tongue. As this was a strange symptom, they discussed it further. It turned out that the patient thought that because it was a heart pill (like nitroglycerin) it should be taken under the tongue. This "mistake" was the first evidence that Isordil could in fact be taken under the tongue, and would work faster by that route. For chasing down that error, my colleague Dr. Henry Russak and his patient deserve a lot of credit, and thanks from all of us.